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Glaucoma

Glaucoma is a disease that causes progressive and irreversible damage to the optic nerve, the structure responsible for carrying visual information from the eye to the brain so that it can be translated into images.

The main risk factor for developing this disease is increased intraocular pressure, which is different from blood pressure. Increased intraocular pressure is detected during an ophthalmologist consultation.

The high incidence of this disease worldwide and the large number of patients in our region made it necessary to acquire advanced technologies for early diagnosis and monitoring of patients at risk or suffering from the disease, since it is a chronic and irreversible condition that, if not treated in a timely and appropriate manner, can lead to blindness.

Parte interna del ojo, nervio óptico con glaucoma

What are the causes of glaucoma?

There is no known cause, but there are many predisposing risk factors, including:

  • Patients with elevated intraocular pressure.
  • Age, over 40 years old.
  • Family history of glaucoma.
  • Patients with high blood pressure, migraine, diabetes, and vascular diseases in general.
  • History of eye trauma.
  • Black, Asian, and Hispanic people.
  • History of uveitis (ocular inflammation).
  • Patients on prolonged treatment with corticosteroids.
  • People with hyperopia (narrow angle).
  • People with myopia.
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Types of glaucoma

Open-angle glaucoma

It is completely asymptomatic. It only manifests when the disease is very advanced and the patient has lost their peripheral visual field, being reduced to the central area (tubular vision).

The onset of visual loss is gradual, progressive, and imperceptible. Only timely revision by an ophthalmologist can lead to early diagnosis and prevent visual limitation.

Initial treatment includes the use of special medication and, if it is not effective, surgical treatment improves fluid drainage.

Depending on the case, there are treatment options with laser.

Closed-angle glaucoma

It is less common and occurs when there is a alteration in the anatomical configuration of the eye. A blockage in the drainage of aqueous humor can occur, resulting in a sudden increase in intraocular pressure, causing symptoms such as pain, red eye, blurred vision, nausea, and vomiting.

It is an ophthalmological emergency and requires immediate treatment. It requires surgical treatment (iridotomy), and also, closed-angle glaucoma can lead to chronic glaucoma.

Regular check-ups are important to detect disease progression.

Everything you need to know about glaucoma surgery

Key facts about glaucoma

Glaucoma is one of the leading causes of irreversible blindness.
Glaucoma can cause blindness if left untreated. Unfortunately, about 10% of people with glaucoma who receive adequate treatment experience vision loss anyway.
There is no cure (yet) for glaucoma.

Glaucoma has no cure, and it is not possible to recover lost vision. With medication and/or surgery, it is possible to stop further vision loss.

As glaucoma is a chronic condition, it must be controlled lifelong.

Diagnosis is the first step in preserving your vision.
Everyone is at risk of developing glaucoma.

Everyone is at risk of developing glaucoma, from babies to older individuals. Older people are at higher risk of developing glaucoma, but babies can be born with this disease.
Young adults can also have glaucoma.

African Americans are particularly susceptible to developing it at an early age.


There may be no warning signs.


In the case of open-angle glaucoma, the most common form, there are virtually no symptoms. Generally, no pain is associated with increased eye pressure.

Vision loss begins with peripheral or lateral vision. It is possible to unconsciously compensate for this loss by moving your head side to side, and you may not notice anything until vision loss is significant.

The best way to protect your vision from glaucoma is through an eye exam. If you have glaucoma, treatment can start immediately.

What are the risk factors for glaucoma?

People at higher risk of glaucoma should have a complete eye exam, including eye dilation, every one to two years, or as recommended by an ophthalmologist.

The following are groups at higher risk of developing glaucoma:

African Americans
Hispanics in older age groups
Steroid users
Eye injury can cause secondary open-angle glaucoma. This type of glaucoma can occur immediately after the injury or years later.
Closed wounds or bruises on the eye (called closed trauma), or penetrating injuries to the eye can damage the eye’s drainage system, leading to traumatic glaucoma.
The most common cause is injuries related to sports such as baseball or boxing, paintball, squash or any other that have some risk of eye injuries.
Other risk factors include:
High myopia (short sight).
Hypertension.
Central corneal thickness of less than 0.5 mm.
Women with hyperopia.
People with high eye pressure.

When should I get tested for glaucoma?

Before the age of 40, every two to four years.

From 40 to 54 years old, every one to three years.

Between 55 and 64 years old, every one to two years.

After 65 years old, every six months to one year.

Anyone with high-risk factors should be examined every one to two years after the age of 35.

What treatments are available for glaucoma?

Glaucoma can be effectively treated with eye drops, pills, laser procedures, conventional surgery, or a combination of these methods.

Usually, the doctor will follow a less invasive to more invasive treatment plan.

The goal of any glaucoma treatment is to prevent vision loss, as it is irreversible.

The good news is that glaucoma can be controlled if detected early and that with medical and/or surgical treatment, the vast majority of people with glaucoma will never lose their vision.

Applying medications regularly as planned is crucial to preventing vision-threatening damage.

We must find motivation, not in fear but in the desire to take care of our eyes, and we must create confidence in our doctor, who will support and help us with any side effects that may occur, which are usually mild.

Can glaucoma heal through surgery?

When medications fail to achieve desired results, or when the side effects are intolerable, your ophthalmologist may suggest surgery.

Argon laser trabeculoplasty (ALT).

The laser treats the trabecular meshwork of the eye, increasing the outflow of drainage fluid and reducing intraocular pressure. In many cases, medications are still necessary. Typically, half of the trabecular meshwork is treated initially. If needed, the other half can be treated as a separate procedure. This method reduces the risk of increased pressure after surgery.

With argon laser trabeculoplasty, intraocular pressure has been reduced by up to 75 percent in treated patients.

Selective laser trabeculoplasty (SLT)

SLT uses nanosecond laser pulses (3nS) of low-energy laser light (0.8mJ average) that selectively target the pigmented cells of the trabecular meshwork (the area of the eye that «filters» aqueous humor). In response to this treatment, there is a physiological «remodeling or cleaning» of dysfunctional structures, which improves the eye’s drainage capacity and reduces intraocular pressure.

None of the treated structures suffer any damage or burns, so the treatment can be repeated in the future when the effectiveness of the first treatment diminishes. It is a very safe and effective modality for cases of glaucoma in the early, intermediate, or advanced stages, when there is intolerance or side effects from chronic medical treatment.

The procedure does not cause disability and eye patching is not necessary.

Peripheral laser iridotomy (LPI) for angle-closure glaucoma.

This procedure is used to create a microscopic opening through the iris, allowing aqueous fluid to flow directly from the iris to the front chamber of the eye. This allows for acute closure of the aqueous humor drainage structure.

Peripheral laser iridotomy is the preferred method for treating angle-closure glaucoma that has some degree of pupillary block.

This laser is most commonly used for treating anatomically narrow angles to prevent acute glaucoma attacks.

Laser cycloablation.

This treatment modality is generally reserved for use in eyes that either have persistently elevated intraocular pressure after other treatments such as filtration surgery (trabeculectomy, valve implants, etc.), painful blind eyes, or eyes where filtration surgery is not possible or advisable due to the shape and other characteristics of the eyes.

Transscleral cyclophotocoagulation uses a laser to direct energy through the sclera (the outer layer of the eye, the white part) to reach the ciliary processes (structures that produce aqueous humor) without causing damage to the overlying tissues. With endoscopic cyclophotocoagulation (ECP), the instrument is placed inside the eye through a surgical incision, allowing the laser energy to be applied directly to the ciliary body tissue under direct visualization. Both aim to reduce intraocular pressure but will not improve the patient’s vision.

Trabeculectomy.

When medications and laser therapy do not sufficiently lower eye pressure, or if pressure levels are dangerously high and pose a risk of worsening optic nerve damage, the specialist may recommend trabeculectomy or filtration surgery. In this procedure, the surgeon creates a drainage pathway for aqueous humor (fluid inside the eye) to the subconjunctival space, thus reducing intraocular pressure.

A «filtration bleb» will form on the top of your eye, acting as a reservoir for aqueous humor while it is absorbed by the blood vessels of the conjunctiva. Sometimes, the surgically created drainage hole starts to close and the intraocular pressure rises again.

This happens because the body tries to heal the new opening as if it were an injury. For this reason, many surgeons perform trabeculectomy while applying an anti-fibrotic medication, which is placed in the eye during surgery to reduce scarring.

This prevents early closure of the fistula (the term for the drainage hole). Trabeculectomy is generally an outpatient procedure. The number of postoperative visits to the doctor varies, and certain activities such as driving, reading, bending, and lifting heavy objects should be limited for two to four weeks after surgery.

Drainage implant surgery (valves).

Several devices have been developed to aid drainage of aqueous humor from the front chamber and reduce intraocular pressure.

All these drainage devices share a similar design, consisting of a small silicone tube that is inserted into the front chamber of the eye. The tube is connected to one or more plates, some of which have a valve mechanism, which is anchored to the sclera of the eye in the space beneath the upper eyelid. Fluid is collected in the plate and then absorbed by the eye tissues.

This type of surgery is intended to reduce pressure in patients whose intraocular pressure cannot be controlled with traditional surgery or who have scars from previous surgeries and certain specific types of glaucoma.

Non-penetrating surgery.

Deep non-penetrating sclerectomy is a type of surgery that does not enter the front chamber of the eye. It is an alternative for reducing postoperative complications and decreasing the risk of infection. However, this surgery often requires greater expertise from the surgeon and generally does not lower intraocular pressure as much as trabeculectomy.

Furthermore, long-term studies are needed to evaluate these procedures and determine their role in the clinical management of glaucoma patients.

Minimally invasive glaucoma surgery (MIGS).

These are the newest alternatives for surgical treatment of glaucoma with mild or moderate damage. As the name suggests, through a smaller incision and using special instruments, drainage pathways for aqueous humor can be created, reducing intraocular pressure. In comparison to trabeculectomy and drainage device implants, they provide less pressure reduction. However, in cases of early-stage glaucoma, combined with cataract surgery, they can achieve sufficient pressure reductions to temporarily discontinue glaucoma eye drops.

Our Glaucoma Specialists

If you have more questions or doubts, feel free to write to us. At Carriazo Clinic, you can find the technology, warmth, and quality to make your procedure an incredible experience.

DRA. ADRIANA QUINTERO FADUL OFTALMÓLOGA, ESPECIALISTA EN GLAUCOMA

Dr. Adriana Quintero Fadul

OPHT SPECIALIST IN GLAUCOMA

Graduated from Hospital Militar in Bogota, specialist in glaucoma, member of the Society of Ophthalmology, the American Academy of Ophthalmology, and the Colombian Working Group on Glaucoma.

DRA. CARMEN ARTETA GRANADOS OFTALMÓLOGA, ESPECIALISTA EN GLAUCOMA

Dr. Carmen Arteta Granados

OPHT SPECIALIST IN GLAUCOMA

Graduated from Universidad del Norte in Barranquilla, specialist in ophthalmology, supra specialist in glaucoma.
Member of the Carriazo Clinic medical staff with over 10 years of experience.

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